The proposed study is an examination of cultural meaning, social interaction, and individual experience in the encounter between 2 culturally distinct approaches to mental illness and its treatment: indigenous Navajo and conventional psychiatric. The study is designed as an ethnography of a new inpatient unit that for the first time will provide on-reservation residential psychiatric care for the most distressed among Navajo youth ages 12-18. Our long-term goal is to produce knowledge of broad use to those concerned with the treatment of adolescents suffering from mental illness in the context of significant cultural differences. The unique integrative nature of the new unit's treatment program suggests that it will be treated as a model for other such facilities in the future, and therefore through-going ethnographic description of the cultural processes relevant to its functioning is necessary and even urgent. Our specific aims are organized under 3 closely interrelated headings pertaining to the meanings that patients, families, and staff attach to the treatment of mental disorder: I.) Clinical Culture and Development of Treatment, tracing the development of a clinical culture and culturally sensitive treatment program in the context of staff, patient, and family expectations and levels of cultural competence among staff; II.) Definitions of Distress and Adolescent Development, comparing concepts of problem, illness, disorder, and stigma defined in psychiatric and indigenous terms, and examining Navajo concepts of adolescent development, growth, and maturity in the context of the contemporary Navajo social milieu; III.) Therapeutic Process and Perception of Treatment, describing patient, family, and staff experience of psychiatric treatment in relation to religious/ceremonial resources tapped by families on behalf of adolescent patients, identifying patterns of youth integration and into communities, and determining whether innovative on-reservation treatment makes a difference for troubled Navajo youth. The design includes a total of 307 participants: 1) patients in the new on-reservation facility, 2) patients drawn from off-reservation facilities, 3) students drawn from a public school on the Navajo Nation, 4) parents of these adolescents, 5) clinical staff, and 6) community advisors. Methods combine naturalistic observation, open-ended ethnographic interviews, and standardized instruments. Analysis emphasizes descriptive ethnography and comparison of narrative case accounts of participant experience and perception of treatment. Ethnography will be complemented by quantitative analyses to determine how youth in the 3 study groups differ on a variety of measures.